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Natural History of the Ocular Surface after Hematopoietic Stem Cell Transplantation
Presenter:
Jordan Tang
Authors:
Tang, Jordan; Ton, Mai-Linh; Crook, Taylor; Unno, Nobuyoshi; Cowman, Arthur; Lee, Olivia L
Ophthalmology, University of California Irvine Gavin Herbert Eye Institute, Irvine, CA, United States.
Affiliation:
Purpose:
To use in vivo confocal microscopy (IVCM), standard ocular surface parameters, and clinical examination to create a comprehensive characterization of ocular surface changes following hematopoietic stem cell transplantation (HSCT).
Methods:
Patients from the UCI Chao Cancer Center’s HSCT Center were referred to the Gavin Herbert Eye Institute for eye examination prior to and at three-month intervals after receiving allogeneic HSCT between 2020 to 2024. A retrospective chart review analyzed results from an ocular surface disease index (OSDI) survey, MMP-9 tear assay, Schirmer’s test, tear break-up time, meibum quality, infrared meibography, bulbar conjunctival and corneal fluorescein staining, and IVCM. Central corneal IVCM images were analyzed with attention to epithelial cells and subbasal nerve plexus; epithelial cells, corneal nerves and dendritic cells density and measurements were quantified by masked graders.
Results:
Linear regression analysis was performed on baseline and follow-up measurements (mean = 8.79 months, max = 30 months) of 86 eyes of 43 HSCT patients without ocular graft versus host disease. Measurements with positive trends included MMP-9 tear assay (p<0.05), dendritic cell count (p<.001), bulbar conjunctival staining (p=0.001), meibum quality (p=0.02), corneal staining (p=0.001), epithelial wing cells (p<0.01), and corneal nerve fiber width (p<0.05). Measurements that trended downwards included corneal nerve fiber density (p<0.01), tear break-up time (p<0.05), and nerve fiber length (p<0.05). No statistically significant trend was noted for Schirmer’s score (p=0.31), OSDI (p=0.69), meibomian gland dropout (p=0.17), epithelial basal cell density (p=0.27), corneal nerve branch density (p=0.47), and corneal nerve fiber area (p=0.96).
Conclusion:
This study characterizes the natural history of the ocular surface following HSCT, suggesting increasing ocular surface inflammation over time with mild changes in clinical exam findings. The described trends may represent asymptomatic but progressive, subclinical changes in the ocular surface associated with immune reconstitution after allogeneic HSCT even in the absence of ocular graft versus host disease.